Gluteus Maximus

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The Gluteus Maximus is a muscle of the gluteal region.

Collectively with the Gluteus Minimus and Gluteus Medius, they maybe referred to as the Glutes.

Anatomical Attachments:

• Origin: Attaches to the superior gluteal line of the ilium, the posterior surface of the sacrum and the side of the coccyx and the length of the sacrotuberous ligament.
• Insertion: Attaches to the iliotibial tract and the deeper fibers are inserted into the gluteal tuberosity of the femur.

Action: Extends and laterally rotates the thigh.

Synergist:  

• Prime Movers: Adductor magnus (posterior part).
• Accessory Movers: Semimembranosus, Semitendinosus, Biceps femoris (long head), Gluteus medius, Piriformis.

Antagonist: Iliopsoas, Pectineus, Tensor fasciae latae, Adductor brevis, Sartorius.

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Nerve Supply: Inferior Gluteal Nerve (L5, S1, S2).

Nerve Entrapment: While no entrapment syndromes have been attributed to this muscle, Travell and Simons state that an entrapment syndrome is possible of the middle Cluneal nerve due to it’s passing through the gluteus maximus to supply the skin.

Vascular supply: Superior and inferior gluteal artery.

• Primary: The pain refers to the buttock region with a spillover into the posterior thigh.
• Satellite or associated triggers: Gluteus medius, Iliopsoas, Rectus femoris, Gluteus minimus, Hamstrings.

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Trigger Point Signs and Symptoms: Cramping pain, restlessness and pain upon prolonged sitting.

Trigger Point Activating and Perpetuating Factors: From a fall or a near fall, leaning forward while walking on uneven ground, swimming, over stretching the muscle, leg exercises, sitting too long in one position, a short first metatarsal bone, persistent sitting with a wallet in the hip pocket, direct trauma to the buttock region.

Differential Diagnosis: Trochanteric bursitis, Sacroiliac joint dysfunction, Lumbar articulating dysfunction, Inflammation of the sub gluteus medius bursa, S1 S2 S3 or S4 nerve compression, Articular dysfunction, (Segmental, Subluxation, Somatic dysfunction) Lower lumbar arthrosis herniation nerve compression (L4, L5 radiculopathy), Sciatica, Intervertebral stenosis, Hip Dislocation, Hip fracture, Hip Pointer, Tensor fasciae latae syndrome, Bone cancer or Malignant neoplasm of the hip, Sacroiliac joint displacement, Coccygodynia, Intervertebral stenosis, Reiter’s disease, Ankylosing Spondylitis, Coxa plana, Pregnancy, Osteoarthritis, Reflex Sympathetic Dystrophy (Complex regional pain syndrome), Polymyalgia rheumatica, Rheumatoid arthritis, Cauda equina syndrome, Eosinophilic fasciitis, Tetanus, Systemic infections or inflammation, Nutritional inadequacy, Metabolic imbalance, Toxicity, Side effects of medication.

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